Clinic Systolic Blood Pressure Research Articles

The dependability, significance, and interrelation between clinic and home blood pressure monitoring

Objective: This study aimed to thoroughly examine and assess the usefulness, precision, and consistency of blood pressure readings in several contexts for the treatment of hypertension. Methods: This cross-sectional study was conducted at Prince Mohammed Medical City in the Al-Jouf region of Saudi Arabia between October 2022 and September 2023. The study comprised of 203 participants with a diagnosis of hypertension who were receiving treatment. The participants were given initial clinical assessment and instructed to independently measure their blood pressure at home at different intervals throughout the day and evening. The process involved meticulously recording each reading. Results: The study involved 203 participants with a mean age of 55 years. Notably, a statistically significant discrepancy between home blood pressure readings and clinic measurements was observed (Clinic SBP: M = 135, SD = 1.09; Home SBP (Day & Evening): M = 121) and (Clinic DBP: M = 76, SD = 0.75; Home DBP (Day & Evening): M = 70) respectively. Additionally, a statistically significant positive correlation between clinic systolic blood pressure and home diastolic blood pressure was (r=0.251, p < 0.001) identified. Conclusion: Compared to measures taken in a clinic, this study offers insightful information about the usefulness and effectiveness of blood pressure monitoring in various contexts. The observed variations underscore the potential benefits of home monitoring in improving blood pressure management tactics and treatment guidance.

The effects of opium consumption on severity of disease on hospitalized COVID-19 patients in East of Iran, a prospective cohort study.

There are few theories and little empirical evidence about the bilateral impact of substance use and coronavirus disease 2019 (COVID-19), so a logical and accurate picture of this area is required. We investigated the effects of opium use on severity of disease on hospitalized COVID-19 patients in east of Iran. Demographic and clinical characteristics, vital signs, laboratory tests, mortality rate, type and duration of opium consumption in hospitalized patients who recovered from COVID-19 in the follow-up after 3 months were evaluated. In this study, 60 (20%) participants were the opium user and 251 (80%) were the non-user patients. Based on clinical symptoms, hypertension and systolic blood pressure in opium user were significantly higher than non-user patients (p < 0.05). In the laboratory tests, only the level of urea was higher in the opium positive group (37 [26.5-48.5] vs. 32 [23-43], respectively) and the percent of lymphocytes were lower in the opium positive (17 [8.2-25.8] vs. 18.7 [13.85-26.35], respectively). The initial therapies of both opium positive and negative infected patients showed not any significant changes (p > 0.05). Among the studied groups, one deceased case with COVID-19 was related to a drug user patient. Although, uses of opium reduced the levels of some risk factors, vital signs at admission and initial therapies during hospitalization in COVID-19 patients but it increased lung and heart diseases. Also, the severity of COVID-19 including hospitalization and mortality were associated with opium consumption.

Homoeopathic management of essential hypertension: A narrative review

Objectives: Hypertension (HTN) or elevated blood pressure is a serious medical condition that significantly increases the risk of heart, brain, kidney, and other diseases. HTN in an adult is said to be present when clinical systolic and diastolic blood pressure exceed 140 mm and 90 mm of hg, respectively. An estimated 1.28 billion people aged 30–79 years have HTN worldwide, most (two-thirds) living in low- and middle-income countries (World Health Organization). Homoeopathy can be useful in managing HTN and its complications, for which a proper knowledge of treatment modalities available in homoeopathy is essential. Materials and Methods: An intensive search of articles, publications, and writings, both online and offline, dealing with the management of essential HTN through homoeopathy was conducted between November 2021 to January 2022. Databases such as Google Scholar, PubMed, ScienceDirect, and various other published books, literature, and anecdotes in homoeopathy were explored, collecting data on the role of homoeopathy in essential HTN. Emphasis was on words such as homoeopathy, HTN, and blood pressure. Results: Management of essential HTN through homoeopathy can be broadly divided into two categories. First, drugs or medicines given in homoeopathic literature, such as Materia Medicas and Repertories, whose choice of administration in HTN depends on the classical methods of prescription, and secondly, drugs or medicines obtained from research outcomes on HTN. Conclusion: In homoeopathic therapeutics, many medicines are available and used in cases of essential HTN. Recently, research activities targeted toward managing HTN through homoeopathy have increased, and data have been generated. Even then, the available data till now are not sufficient in bringing homoeopathy equivalent or near to the conventional system of medicine in managing HTN demands; in turn, more research works in homoeopathy with statistical rigour.

Preeclampsia Prediction Using Machine Learning and Polygenic Risk Scores From Clinical and Genetic Risk Factors in Early and Late Pregnancies.

Preeclampsia, a pregnancy-specific condition associated with new-onset hypertension after 20-weeks gestation, is a leading cause of maternal and neonatal morbidity and mortality. Predictive tools to understand which individuals are most at risk are needed. We identified a cohort of N=1125 pregnant individuals who delivered between May 2015 and May 2022 at Mass General Brigham Hospitals with available electronic health record data and linked genetic data. Using clinical electronic health record data and systolic blood pressure polygenic risk scores derived from a large genome-wide association study, we developed machine learning (XGBoost) and logistic regression models to predict preeclampsia risk. Pregnant individuals with a systolic blood pressure polygenic risk score in the top quartile had higher blood pressures throughout pregnancy compared with patients within the lowest quartile systolic blood pressure polygenic risk score. In the first trimester, the most predictive model was XGBoost, with an area under the curve of 0.74. In late pregnancy, with data obtained up to the delivery admission, the best-performing model was XGBoost using clinical variables, which achieved an area under the curve of 0.91. Adding the systolic blood pressure polygenic risk score to the models did not improve the performance significantly based on De Long test comparing the area under the curve of models with and without the polygenic score. Integrating clinical factors into predictive models can inform personalized preeclampsia risk and achieve higher predictive power than the current practice. In the future, personalized tools can be implemented to identify high-risk patients for preventative therapies and timely intervention to improve adverse maternal and neonatal outcomes.

Home versus Clinic Blood Pressure Monitoring: Evaluating Applicability in Hypertension Management via Telemedicine.

Hypertension is a significant public health concern in Saudi Arabia, affecting 28.6% of the population. Despite the availability of effective treatments, optimal blood pressure control is not always achieved, highlighting the need for effective management strategies. This study aimed to evaluate the applicability of home, compared to clinic, blood pressure measurements for managing hypertension in the Qassim region of Saudi Arabia. The study included 85 adults undergoing antihypertensive treatment. Home blood pressure measurements were obtained during the day and the evening using automated oscillometric sphygmomanometers, whereas clinic measurements were taken during clinic hours. Home blood pressure readings were significantly lower than clinic blood pressure readings, with mean differences of 20.4 mmHg and 4.1 mmHg for systolic and diastolic blood pressures, respectively. There was a positive correlation between the clinic systolic and diastolic blood pressures (r = 0.549, p < 0.001) and a weak correlation between the daytime home and clinic systolic blood pressures (r = 0.218, p < 0.05). This study provides insight into the applicability of home blood pressure monitoring, which may aid in the development of more effective hypertension management strategies, particularly the use of morning home blood pressure monitoring to aid treatment decisions through telehealth medicine.

Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol

Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions. The NEXTGEN-BP open-label, multicenter, randomized controlled trial will investigate the efficacy, safety, acceptability and cost-effectiveness of a wearable blood pressure monitor-based care strategy for the treatment of hypertension, compared to usual care, in lowering clinic blood pressure over 12 months. NEXTGEN-BP will enroll 600 adults with high blood pressure, treated with 0 to 2 antihypertensive medications. Participants attending primary care practices in Australia will be randomized 1:1 to the intervention of a wearable-based remote care strategy or to usual care. Participants in the intervention arm will undergo continuous blood pressure monitoring using a wrist-wearable cuffless device (Aktiia, Switzerland) and participate in 2 telehealth consultations with their primary care practitioner (general practitioner [GP]) at months 1 and 2. Antihypertensive medication will be up-titrated by the primary care practitioner at the time of telehealth consults should the percentage of daytime blood pressure at target over the past week be <90%, if clinically tolerated. Participants in the usual care arm will have primary care consultations according to usual practice. The primary outcome is the difference between intervention and control in change in clinic systolic blood pressure from baseline to 12 months. Secondary outcomes will be assessed at month 3 and month 12, and include acceptability to patients and practitioners, cost-effectiveness, safety, medication adherence and patient engagement. NEXTGEN-BP will provide evidence for the effectiveness and safety of a new paradigm of wearable cuffless monitoring in the management of high blood pressure in primary care. ACTRN12622001583730.

Leveraging Electronic Health Record Technology and Team Care to Address Medication Adherence: Protocol for a Cluster Randomized Controlled Trial.

Low medication adherence is a common cause of high blood pressure but is often unrecognized in clinical practice. Electronic data linkages between electronic health records (EHRs) and pharmacies offer the opportunity to identify low medication adherence, which can be used for interventions at the point of care. We developed a multicomponent intervention that uses linked EHR and pharmacy data to automatically identify patients with elevated blood pressure and low medication adherence. The intervention then combines team-based care with EHR-based workflows to address medication nonadherence. This study aims to describe the design of the Leveraging EHR Technology and Team Care to Address Medication Adherence (TEAMLET) trial, which tests the effectiveness of a multicomponent intervention that leverages EHR-based data and team-based care on medication adherence among patients with hypertension. TEAMLET is a pragmatic, cluster randomized controlled trial in which 10 primary care practices will be randomized 1:1 to the multicomponent intervention or usual care. We will include all patients with hypertension and low medication adherence who are seen at enrolled practices. The primary outcome is medication adherence, as measured by the proportion of days covered, and the secondary outcome is clinic systolic blood pressure. We will also assess intervention implementation, including adoption, acceptability, fidelity, cost, and sustainability. As of May 2023, we have randomized 10 primary care practices into the study, with 5 practices assigned to each arm of the trial. The enrollment for the study commenced on October 5, 2022, and the trial is currently ongoing. We anticipate patient recruitment to go through the fall of 2023 and the primary outcomes to be assessed in the fall of 2024. The TEAMLET trial will evaluate the effectiveness of a multicomponent intervention that leverages EHR-based data and team-based care on medication adherence. If successful, the intervention could offer a scalable approach to address inadequate blood pressure control among millions of patients with hypertension. ClinicalTrials.gov NCT05349422; https://clinicaltrials.gov/ct2/show/NCT05349422. DERR1-10.2196/47930.

CORRELATION BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE MEASUREMENT

Objective: Blood pressure (BP) measurements taken in the clinic provide limited information about the BP load. Ambulatory blood pressure monitoring (ABPM) provide a more comprehensive assessment of blood pressure over the course of a day. This study examined the correlation between clinic and ambulatory BP measurements. Design and method: We collated clinic and 24 hour ambulatory BP data of 100 patients aged &gt; 18 years from the outpatient cardiology clinic of Mohamed Taher Maamouri University hospital in Nabeul (n = 100) over a six months period (July-December 2021). Laying of ABPM was performed using a Bravo Mini validated device from Sun Tech Medical. We used the Pearson correlation coefficient (r) to measure the strength of the relationship between these two measurements methods. Results: The mean age of our population was 59.14±13.12 years (range 21-92 years), composed of 47 women and 53 men. The most frequent reason for carrying out ABPM was the monitoring of hypertensive patients in 84% of cases, 16% were done to confirm the diagnosis of hypertension. ABPM confirmed the diagnosis of hypertension in 62.5% and detected 18.75% isolated nocturnal hypertension in patients with suspected hypertension and 14.3% masked uncontrolled nocturnal hypertension in hypertensive patients. Concordance was found in 66% of cases between clinic measurement and the 24-hour ABPM data. There was a weak correlation between clinic systolic BP and 24-hour ambulatory systolic BP (P &lt;0.001; r = 0.349; Curve A) and moderate correlation between clinic diastolic BP and 24-hour ambulatory diastolic BP (P &lt;0.001; r = 0.566; Curve B). Conclusions: The correlation between these two methods isn’t important mainly explained by variation of BP especially at night detected by ABPM which remains the reference method for diagnosing and monitoring hypertension

24HOUR, HOME AND CLINIC BLOOD PRESSURE FOR THE PREDICTION OF LEFT VENTRICULAR HYPERTROPHY IN UNTREATED HYPERTENSIVE POPULATION

Objective: The aim of this study was to investigate which way of measuring blood pressure (BP), clinic, home or 24h-ABPM, can predict better left ventricular hypertrophy in the untreated hypertensive population. Design and method: 175 consecutive subjects (42% male) aged 57.9±14.9 years were included in the study. Subjects were never treated before for hypertension. All subjects underwent 24h-ABPM on a usual working day. Home BP monitor was provided to all patients for 7 days, while office BP was measured in the clinic using a mercury sphygmomanometer. Left ventricular hypertrophy was evaluated by a cardiologist with the use of a 3D echocardiography. Results: In the univariate analysis, only home systolic and diastolic BP were independently associated with left ventricular hypertrophy, while both clinic and 24hour systolic and diastolic BP found not to be. From ROC curves for left ventricular hypertrophy, AUC of home systolic BP monitor (0.758, p&lt;0.05) was larger than that of 24h (0.538, p&gt;0.05) and clinic BP (0.497, p&lt;0.05). As regards DBP, the ROC curves suggest no discrimination for the different ways of BP measurement. Conclusions: Home systolic BP can be a better predictor of left ventricular hypertrophy in untreated population, when compared to 24h and office systolic BP. This result shows the importance of home monitoring for the prediction of left ventricular hypertrophy, even in the untreated population.

Monitoring of the regulatory ability and regulatory state of the autonomic nervous system and its application to the management of hypertensive patients: a study protocol for randomised controlled trials

IntroductionMany causes lead to sympathetic-vagus imbalance, which promotes the development of hypertension and accelerates the process of target organ damage. Many studies have shown that exercise training and heart rate...

THE DIFFERENCE IN BLOOD PRESSURE BETWEEN THE TUNNEL BLOOD PRESSURE MONITORS IN THE WAITING AREA AND UPPER ARM BLOOD PRESSURE MONITORS IN THE CLINIC

Objective: Tunnel blood pressure as an out-of-clinic screening program is often more casual, and its consistency with office blood pressure dominated by upper arm blood pressure and whether it can replace office blood pressure remains unclear. The aim of this study was to analyze the differences between the two blood pressure measurements. Design and method: The study dates from the Majiapu community, which is a big community in Beijing. We analyzed blood pressure with different measurements containing tunnel (waiting area,9002P) and upper arm (clinic, OMRON 1120U) blood pressure measurements. We compare the two measurements by the mean average value and standard deviation (SD) of the two measurements. Besides, we compare the mean blood pressure in the subgroups which contain the age, sex, blood lipids, blood glucose, and different blood pressure levels. Results: In this study, a cohort of 35069 individuals aged 0 to 105 years, 19443 were randomly assigned to the tunnel blood pressure measurement group (TBPG) and 15626 to the upper arm blood pressure measurement group (UBPG). The qualified rate of the UBPG was 64.76% in 140/90 mm Hg and 54.66% in 130/80 mm Hg. In baseline, the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 134.0±21.3 mm Hg and 76.3±12.0 in the TBPG, 134.9±22.3 mm Hg and 80.3±12.5 in the UBPG. In the age more than 60 years subgroup, the mean SBP in the TBPG with 139.0±21.1 mm Hg was similar to the other group, which was 138.5±22.4 mm Hg, the mean DBP was on the contrary, which was 74.8±11.4 and 79.6±11.9 mm Hg respectively. Similar results can be found in the age&lt; 60 years, sex, blood lipids, and blood glucose subgroups. In the BP more than 140/90 mmHg subgroup, the SBP difference was only 0.1 mmHg, but the DBP was 5 mmHg, as same as the BP more than 130/80 mmHg subgroup. The DBP difference was much smaller in the low BP level. Conclusions: The clinic SBP for the tunnel (waiting area) and upper arm (clinic) blood pressure monitors were similar, but the DBP differ significantly between the two groups.

Using urinary metabolomics to identify metabolic pathways linked to cardiac structural alterations in young adults: The African-PREDICT study

Background and aimsRisk factor exposure from young ages was shown to contribute to cardiovascular events - cardiac hypertrophy, which may be accompanied by an altered metabolism. To determine how early metabolic alterations associate with myocardial structural changes, we profiled urinary metabolites in young adults with cardiovascular disease (CVD) risk factor(s) and a control group without CVD risk factors. Methods and resultsWe included healthy adults (N = 1202), aged 20–30 years, stratified based on risk factors, i.e., obesity, physical inactivity, elevated blood pressure (BP), hyperglycemia, dyslipidemia, low socio-economic status, smoking and excessive alcohol use - forming the CVD risk group (N = 1036) and the control group (N = 166). Relative wall thickness (RWT) and left ventricular mass index (LVMi) were measured using echocardiography. Targeted metabolomics data were obtained using a liquid chromatography-tandem mass spectrometry method. Clinic systolic BP, 24 h BP and RWT were higher in the CVD risk group compared to the control group (all P ≤ 0.031). Exclusively in the CVD risk group, RWT associated with creatine and dodecanoylcarnitine; while LVMi associated with glycine, serine, glutamine, threonine, alanine, citrulline, creatine, proline, pyroglutamic acid and glutamic acid (all P ≤ 0.040). Exclusively in the control group, LVMi associated with propionylcarnitine and butyrylcarnitine (all P ≤ 0.009). ConclusionIn young adults without CVD, but with CVD risk factors, LVMi and RWT associated with metabolites linked energy metabolism (shifting from solely fatty acid oxidation to glycolysis, with impaired creatine kinase activity) and oxidative stress. Our findings support early onset metabolic changes accompanying cardiac structural alterations due to lifestyle and behavioural risk factors.

Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients

Ambulatory blood pressure provides a more comprehensive assessment than clinic blood pressure, and has been reported to better predict health outcomes than clinic or home pressure. We aimed to examine associations of clinic and 24-h ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of primary care patients referred for assessment of hypertension. We did an observational cohort study using clinic and ambulatory blood pressure data obtained from March 1, 2004, to Dec 31, 2014, from the Spanish Ambulatory Blood Pressure Registry. This registry included patients from 223 primary care centres from the Spanish National Health System in all 17 regions of Spain. Mortality data (date and cause) were ascertained by a computerised search of the vital registry of the Spanish National Institute of Statistics. Complete data were available for age, sex, all blood pressure measures, and BMI. For each study participant, follow-up was from the date of their recruitment to the date of death or Dec 31, 2019, whichever occurred first. Cox models were used to estimate associations between usual clinic or ambulatory blood pressure and mortality, adjusted for confounders and additionally for alternative measures of blood pressure. For each measure of blood pressure, we created five groups (ie, fifths) defined by quintiles of that measure among those who subsequently died. During a median follow-up of 9·7 years, 7174 (12·1%) of 59 124 patients died, including 2361 (4·0%) from cardiovascular causes. J-shaped associations were observed for several blood pressure measures. Among the top four baseline-defined fifths, 24-h systolic blood pressure was more strongly associated with all-cause death (hazard ratio [HR] 1·41 per 1 - SD increment [95% CI 1·36-1·47]) than clinic systolic blood pressure (1·18 [1·13-1·23]). After adjustment for clinic blood pressure, 24-h blood pressure remained strongly associated with all-cause deaths (HR 1·43 [95% CI 1·37-1·49]), but the association between clinic blood pressure and all-cause death was attenuated when adjusted for 24-h blood pressure (1·04 [1·00-1·09]). Compared with the informativeness of clinic systolic blood pressure (100%), night-time systolic blood pressure was most informative about risk of all-cause death (591%) and cardiovascular death (604%). Relative to blood pressure within the normal range, elevated all-cause mortality risks were observed for masked hypertension (HR 1·24 [95% CI 1·12-1·37]) and sustained hypertension (1·24 [1·15-1·32]), but not white-coat hypertension, and elevated cardiovascular mortality risks were observed for masked hypertension (1·37 [1·15-1·63]) and sustained hypertension (1·38 [1·22-1·55]), but not white-coat hypertension. Ambulatory blood pressure, particularly night-time blood pressure, was more informative about the risk of all-cause death and cardiovascular death than clinic blood pressure. Spanish Society of Hypertension, Lacer Laboratories, UK Medical Research Council, Health Data Research UK, National Institute for Health and Care Research Biomedical Research Centres (Oxford and University College London Hospitals), and British Heart Foundation Centre for Research Excellence.

Effect of weight loss on blood pressure changes in overweight patients: A systematic review and meta-analysis.

To determine quantitative differences between weight loss and changes in clinic blood pressure (BP) and ambulatory BP in patients with obesity or overweight, the authors performed a meta-analysis. PubMed, Embase, and Scopus databases were searched up to June 2022. Studies that compared clinic or ambulatory BP with weight loss were included. A random effect model was applied to pool the differences between clinic BP and ambulatory BP. Thirty-five studies, for a total of 3219 patients were included in this meta-analysis. The clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced by 5.79mmHg (95% CI, 3.54-8.05) and 3.36mmHg (95% CI, 1.93-4.75) after a mean body mass index (BMI) reduction of 2.27 kg/m2 , and the SBP and DBP were significantly reduced by 6.65mmHg (95% CI, 5.16-8.14) and 3.63mmHg (95% CI, 2.03-5.24) after a mean BMI reduction of 4.12 kg/m2 . The BP reductions were much larger in patients with a BMI decrease ≥3kg/m2 than in patients with less BMI decrease, both for clinic SBP [8.54mmHg (95% CI, 4.62-12.47)] versus [3.83mmHg (95% CI, 1.22-6.45)] and clinic DBP [3.45mmHg (95% CI, 1.59-5.30)] versus [3.15mmHg (95% CI, 1.21-5.10)]. The significant reduction of the clinic and ambulatory BP followed the weight loss, and this phenomenon could be more notable after medical intervention and a larger weight loss.

Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults

Uncontrolled hypertension (ie, a 24-hour ambulatory systolic blood pressure of ≥130 mm Hg and diastolic blood pressure of ≥80 mm Hg or clinic systolic blood pressure of ≥140 mm Hg and diastolic blood pressure of ≥90 mm Hg) in young adults is a US public health burden. To evaluate the effect of a telephone coaching and blood pressure self-monitoring intervention compared with usual care on changes in systolic and diastolic blood pressures and behaviors at 6 and 12 months. This randomized clinical trial included male and female participants aged 18 to 39 years with uncontrolled hypertension confirmed by 24-hour ambulatory blood pressure testing. This was a geographically diverse, multicentered study within 2 large, Midwestern health care systems. Data were collected from October 2017 to February 2022 and analyzed from February to June 2022. The My Hypertension Education and Reaching Target (MyHEART) intervention consisted of telephone coaching every 2 weeks for 6 months, with home blood pressure monitoring. Control participants received routine hypertension care. The co-primary clinical outcomes were changes in 24-hour ambulatory and clinic systolic and diastolic blood pressure at 6 and 12 months. The secondary outcomes were hypertension control (defined as ambulatory systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg or clinic systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and changes in hypertension self-management behavior. A total of 316 participants were randomized (159 to the control group and 157 to the intervention group) from October 2017 to December 2020. The median (IQR) age was 35 (31-37) years, 145 of 311 participants (46.6%) were female, and 166 (53.4%) were male; 72 (22.8%) were Black, and 222 (70.3%) were White. There were no differences in baseline characteristics between groups. There was no significant difference between control and intervention groups for mean 24-hour ambulatory systolic or diastolic blood pressure or clinic systolic or diastolic blood pressure at 6 or 12 months. However, there was appreciable clinical reduction in blood pressures in both study groups (eg, mean [SD] change in systolic blood pressure in intervention group at 6 months, -4.19 [9.77] mm Hg; P < .001). Hypertension control did not differ between study groups. Participants in the intervention group demonstrated a significant increase in home blood pressure monitoring at 6 and 12 months (eg, 13 of 152 participants [8.6%] checked blood pressure at home at least once a week at baseline vs 30 of 86 [34.9%] at 12 months; P < .001). There was a significant increase in physical activity, defined as active by the Godin-Shephard Leisure-Time Physical Activity Questionnaire, in the intervention group at 6 months (69 of 100 [69.0%] vs 51 of 104 [49.0%]; P = .004) but not at 12 months (49 of 86 [57.0%] vs 49 of 90 [54.4%]; P = .76). There was a significant reduction in mean (SD) sodium intake among intervention participants at 6 months (3968.20 [1725.17] mg vs 3354.72 [1365.75] mg; P = .003) but not 12 months. There were no significant differences in other dietary measures. The MyHEART intervention did not demonstrate a significant change in systolic or diastolic blood pressures at 6 or 12 months between study groups; however, both study groups had an appreciable reduction in blood pressure. Intervention participants had a significant reduction in dietary sodium intake, increased physical activity, and increased home blood pressure monitoring compared with control participants. These findings suggest that the MyHEART intervention could support behavioral changes in young adults with uncontrolled hypertension. ClinicalTrials.gov Identifier: NCT03158051.

PS-P15-2: CHANGES IN HOME BLOOD PRESSURE VARIABILITY DURING DOWN-TITRATION OF ANTIHYPERTENSIVE DRUGS IN PATIENT WITH SYSTOLIC HOME BLOOD PRESSURE BELOW 120MMHG

Background: In the guideline recommendation for intensive blood pressure (BP) control, there has been a concern for the J-curve phenomenon so European guidelines recommended down-titration if systolic BP (SBP) lowered below 120 mmHg. But there is no studies for the changes in BP and BP variability with down-titration. Aim of the study is to test the hypothesis that BP variability could be increased with down-titration. Methods: In a retrospective study, 82 patients undergone down-titration in whom home BP monitoring (HBPM) before and after were available were analyzed during 2020.09.01∼2022.05.31. During this period, the guideline directed medical therapy was to down-titrate when home SBP was below 120 mmHg. When preclinic SBP below 120 mmHg, down-titration was performed when home SBP was less than 120 mmHg in the next visit or incidental home SBP less than 120 mmHg regardless of clinic SBP level. Minimal and maximal required numbers of readings in HBPM were 8 and 40. Average and standard deviation (SD) were compared before after down-titration. Results: Mean age was 66.2(34∼95) years and female readings were 44 (53.7%). Preclinic SBP was 122.4 + /-17.5 mmHg and clinic SBP was 121.9 +/-14.2 mmHg at baseline (BL). Clinic SBP at follow up (FU) was 126.4 +/-15.5 mmHg. History of cardiovascular diseases, diabetes and hyperlipidemia were present in 17%, 32.9%, and 69.5%, respectively. Numbers of AHMS were 1 in 26.8%, 2 in 30.5%, 3 in 32.9%, and 4 in 9.7%. The uses of renin angiotensin blockade, beta blocker, calcium antagonist, and diuretics were 84.1%, 36.5%, 75.6% and 29.3%, respectively. Home SBP was increased significantly (111.6 mmHg BL, 118.8mmHg FU, p &lt; 0.0001). SD of home SBP did not increased significantly (3.5 mmHg BL, 3.4 mmHg FU, p = 0.85). Home diastolic BP (DBP) was also increased significantly (68.7 mmHg BL, 72.8 mmHg FU, p &lt; 0.0001). SD of home DBP did not changed (2.2 mmHg BL, 1.6 mmHg, p = 0.55). Conclusion: When antihypertensive drug was down-titrated due to excessive lowering of systolic BP less than 120 mmHg, mean BPs were increased modestly without increase in BP variability. Current guideline directed down-titration should be safe without increasing BP variability.

S-28-6: URINARY METABOLOMICS, DIETARY SALT INTAKE AND BLOOD PRESSURE: THE AFRICAN-PREDICT STUDY

Objective: Excessive salt intake is the leading dietary risk factor for cardiovascular disease (CVD). This increased risk may be attributed to alterations in the human metabolome. Salt sensitivity is associated with ethnicity, and ethnic differences in the interaction between sodium intake and the metabolome may play an integral part in CVD development. We therefore investigated 1) the urinary metabolomic profiles of Black and White adults according to low, moderate and high dietary salt intake; and 2) explored the relationships of identified metabolites with blood pressure. Design and Methods: This study included data of White (N = 447) and Black (N = 380) adults aged 20 to 30 years from the African-PREDICT study. Estimated salt intake was determined from 24hr urinary sodium. Urinary amino acids and acylcarnitines were measured using liquid chromatography tandem mass spectrometry. Clinic, 24hr and central systolic blood pressure (SBP) were measured. Results: Whites with a high salt intake (&gt; 10 g/day) had higher SBP (clinic, 24hr and central) compared to those with low (&lt; 5 g/day) or moderate (5 to 10 g/day) salt intakes (all p &lt; 0.05). The metabolites GABA (q = 0.020), citrulline (q = 0.020), glutamic acid (q = 0.046), serine (q = 0.054) and proline (q = 0.054) were lower in those with higher salt intake. In stepwise multivariable adjusted regression analyses, we found that clinic SBP of white adults were inversely associated with GABA (Adj. R2 = 0.35; Std. β=-0.123; p = 0.005), serine (Adj. R2 = 0.35; Std. β=-0.099; p = 0.022) and proline (Adj. R2 = 0.35; Std. β=-0.099; p = 0.021), and central SBP with GABA (Adj. R2 = 0.34; Std. β=-0.094; p = 0.036), glutamic acid (Adj. R2 = 0.34; Std. β=-0.090; p = 0.035) and proline (Adj. R2 = 0.034; Std. β=-0.106; p = 0.015). In Black adults, there were no differences in SBP or metabolites between low, moderate or high salt intake groups, with no relationships between SBP and GABA, glutamic acid, citrulline, serine or proline. Conclusion: In White adults, high salt intake was associated with low levels of GABA, glutamic acid, serine and proline, which in turn were related to high SBP. We hypothesise that metabolomic changes are related to salt intake and may contribute to pathophysiological mechanisms associated with increased blood pressure.

PS-C35-3: EFFECT OF BMI REDUCTION ON BLOOD PRESSURE CHANGES IN OVERWEIGHT PATIENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: To determine quantitative differences between weight loss and changes in clinic blood pressure (BP) in overweight patient, a systematic review and meta-analysis of randomised trials was performed. Design and method: A systematic literature search was conducted to identify relevant studies in the PubMed, Embase and Scopus databases up to April 2022. Only studies with English language were included. Studies were considered for inclusion if they met the following criteria: (1) included comparison clinical BP between weight loss; (2) the mean values and standard deviations (SD) of clinical BP and BMI were reported respectively; (3)all patients have a BMI ≧ 25 kg/m2. The certainty of evidence was used the GRADE approach. All statistical analyses were performed using Revman 5. Results: Twenty-four studies, for a total of 2614 patients were included in this meta-analysis. The clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced by 7.04 mmHg (95% CI, 5.04–9.03) and 4.40 mmHg (95% CI, 3.17–5.62) after a mean body mass index (BMI) reduction of 2.42 Kg/m2. The BP reductions were much larger in patients with a BMI decrease ≧ 3 kg/m2 than in patient with less BMI decrease, both for SBP [10.32 mmHg (95% CI, 6.15–14.49)] vs. [5.79 mmHg (95% CI, 3.19–8.39)] and DBP [7.48 mmHg (95% CI, 4.50–10.47)] vs [3.93 mmHg (95% CI, 2.15–5.70)]. The BP reductions were also much larger in patients with a baseline BMI ≧ 30 kg/m2 than in patients with a lower BMI, both for SBP [8.90 mmHg (95% CI, 5.97–11.83) vs. 5.25 mmHg (95% CI, 2.19–8.31)] and DBP [6.02 mmHg (95% CI, 3.89–8.14) vs. 3.82 mmHg (95% CI, 1.78–5.86)]. Furthermore, the SBP and DBP reductions in patients with medical interventions (ie drugs and surgeries) were 9.22 mmHg (95% CI, 6.36–12.08) and 6.11 mmHg (95% CI, 3.29–8.92) respectively, which were larger than patients with lifestyle interventions both for SBP [4.69 mmHg (95% CI, 2.81–6.57)] and DBP [3.82 mmHg (95% CI, 2.22–5.43)]. Conclusions: The significant reduction of clinic BP followed the weight loss, and this phenomenon could be more notable after medical intervention and a larger weight loss.

PS-P01-9: RELATIONSHIP BETWEEN BLOOD PRESSURE AND FRAILTY IN ELDERLY PATIENTS WITH ANY CARDIOMETABOLIC RISK FACTORS

Background: High blood pressure in mid-life was associated with frailty in elderly patients; however, frail patients have reduced quality of life (QOL) causing blood pressure decline. We thought to evaluated relationship between the blood pressure and frailty. Methods: We registered 691 elderly patients who had any cardiometabolic risk factors (hypertension, diabetes, dyslipidemia, atrial fibrillation, and heart failure) between Sep. 2015 and April 2022, and follow up for 1 year (N = 363). Clinic blood pressure (CBP) was taken twice in a seated position, using semi-automatic upper arm device, without doctors or nurses present. Frailty was evaluated using modified Japanese Cardiovascular Health Study score (J-CHS) that included appendicular skeletal muscle index, hand grip strength, and walk speed, and Kihon check list (KCL) that included QOL associated with frailty. Results: Mean age was 79.2 ± 6.3 years (male 35.6%). There were 30.4 % of patients with frailty by J-CHS criteria and 38.0 % by KCL criteria. In the multivariate-adjusted logistic regression analysis, frailty by J-CHS criteria was significantly associated with lower clinic DBP (OR = 0.901 per 5 mmHg increase, 95%CI, 0.829–0.978, P = 0.013); frailty by KCL criteria was with lower clinic SBP (OR = 0.843 per 10 mmHg increase, 95%CI 0.761–0.933, P = 0.001). In patients with antihypertensive medication, frailty with KCL was associated with clinic SBP (OR = 0.815 per 10 mmHg increase, 95%CI 0.703–0.944, P = 0.006). In frail patients by J-CHS criteria at baseline, low clinic DBP at baseline (OR = 0.937 per 1 mmHg increase, 95%CI 0.883–0.994, P = 0.031) and change in clinic DBP (OR = 0.921 per 1 mmHg change, 95%CI 0.861–0.986, P = 0.018) were associated with sustained frailty at 1 year later. In patients with preserved walk speed (&gt; 1.0m/sec) at baseline, change in clinic DBP was associated with development of reduced walk speed (&lt; 1.0m/s) at 1 year later (OR = 0.945, 95%CI 0.893–0.999, P = 0.046). Conclusion: Frailty was associated with lower clinic systolic or diastolic blood pressure, and change in clinic DBP in elderly patients with cardiometabolic risk factors.

Early Pregnancy Blood Pressure Trajectories Predict Preeclampsia and Gestational Hypertension Among Low Risk Pregnancies

Develop and validate a prediction model for risk of preeclampsia (PE) and gestational hypertension (GH) using early pregnancy blood pressure (BP) patterns plus risk factors (RF) routinely available in clinical settings among low and moderate risk pregnancies. Retrospective cohort of 249,892 low or moderate risk singleton pregnancies delivered at Kaiser Permanente Northern California hospitals in 2009-2019. Electronic health records excluded prior hypertension, heart, kidney or liver disease and history of PE. All BPs were < 140/90 at < 20 weeks gestation. Data were randomly divided into a training dataset (N=174,925;70%) for model development and a validation dataset (n=74,967;30%). We used group-based trajectory modeling of longitudinal clinical systolic BPs to identify early pregnancy BP trajectory (BPT) groups < 20 weeks. We fit multinomial logistic regression models to predict early PE (< 34 weeks), late PE (≥34 weeks) and GH including BPT alone or with multiple RF (BMI, parity, age, race/ethnicity, diabetes) vs. an initial BP alone or with other RF. C-statistics generated from the validation dataset evaluated model predictive performance. The sample of 249,892 low to moderate risk individuals had mean (SD) maternal age of 30.9 y (5.3), BMI of 26.0 kg/m2 (5.8), 57% were nulliparous, and 63% were from Black, Hispanic, or Asian groups, and 100% had all normal BPs < 20 weeks. Overall, 992 (0.4%) developed early PE, 10,612 (4.3%) late PE, and 10,854 (4.3%) GH. BPT group models performed much better (C-statistic:0.664-0.732) than models with initial BP only (0.630-0.700), multiple RF alone, or in combination (Table 1). The best model performance (0.729-0.768) to predict early PE, late PE and GH included BPT groups plus BMI, parity, age, race/ethnicity, and diabetes. Six BP patterns plus RF available in routine clinical care improved prediction of early and late PE, and GH in lower risk pregnancies. Our findings show promise to guide surveillance and strategies to distinguish risk among ostensibly low risk groups.